Feb 19, 2012. Time flies. I have written a follow-up on the interesting cases I saw on Chinese New Year 2nd day on Jan 24, 2012. The webpage and images are at:
839. Chinese New Year 2nd day - salivation - stinks the whole apartment
Tuesday Jan 24, 2012
Chinese New Year 2nd day
Bright sunshine day. All neighbours closed
I came to check on my cat patient - a stray cat with badly wounded left fore paw and swollen right paw and do some stock checking and administration.
5052 - 5055. A stray cat's serious fight wounds. I got a video produced by Nicole and this is at:
How to clean a badly wounded cat's paw wound, demonstrated by Dr Sing Kong Yuen
1. Shih Tzu, Female, 11 years. Fever. EMACIATED. Sticky salivation as gums were ulcerated as if he had licked some poison some 4 days ago.
"Whole apartment smelly," the father said. The son of 24 years was very concerned. "Yellow liquid in his mouth. What is it?" he asked me. "Could be gastric juice vomited. Did he lick any liquid like paint or tick insecticide?"
"There was anti-mosquito fogging 5 days ago," the son said.
"Yes, it is possible the dog tried to lick off the smell. A blood test is recommended. But you have to decide."
"We are poor. Don't want the blood test," the father said. The son later told me that a vet had forced his father to take various tests leading to a hefty vet bill. So, the father is angry at all vets. However, his vet is off today. Treatment. IV drip, antibiotics and anti-fever. Dental work advised.
UPDATE: Feb 19, 2012. The owner did not return for review.
2. Jack Russell, Male, 11 years. High fever. Massive swelling below R eye for past 5 days. The elder brother said: "The swelling comes and goes, but today, it expands. Can't open eye. What is it?"
4990 - 4999. Abscess caused by two maxillary molar teeth. High fever. Anaesthesia to extract the two loose right maxillary molars was very risky. IV drips, antibiotics and anti-fever 24 hours first
No dental work for past 11 years. Malar abscess? "Any bee stings?" I asked.
"Centipede sting possible as there are lots of centipedes in the house." A son and mum phoned at 5pm. "Not much changes," I said. Swelling has defined to a ping-pong sized lump after IV drip and medication. Will need sedation tomorrow to see inside the mouth as the dog prohibited opening of his mouth.
Could be an abscess not related to malar abscess or a haematoma. Vet medicine is full of surprises.
UPDATE: Feb 19, 2012. The owner did not return for review of the right cheek wound. I presume it had closed by granulation as it would be too big to stitch up. I suspect this case is due to a flesh-eating bacterial infection as it is not typical of a malar abscess.
3. Persian cat of a son who is studying overseas. F, 13 years, not spayed. EMACIATED. Drooling. Mum went on holiday past 2 weeks and now the cat had problems not eating. salivation. Two large cystic swelling below and beside the tongue. Wandered outdoors as mum was not around. Could it be ingestion of poison? IV and medication.
5067 - 5071.
LPGS - lymphocytic plasmacytic gingivitis stomatitis in an old cat
UPDATE: Feb 19, 2012. To my surprise, the mother reported that the Persian cat was back to normal, eating and putting on weight. Her son, studying in Australia was happy as this was his cat. LPGS (lymphocytic plasmacytic gingivitis stomatitis) is diagnosed by biopsy of the ulcerated oral tissues, but this would cost the owner more money.
Therefore, I did not practise defensive medicine as I did not insist on getting this test done as the signs and symptoms were quite clear. The causes of LPGS are varied as there is no one cause known. It included stress, viral and bacterial infections (FIV, feline leukemia, feline calcivirus, Bartonella henselae bacteria, genetic predisposition, sensitivity of gums to bacterial plaque by provoking the aggressive inflammatory response sending large amounts of lymphocytes and plasma cells (two types of white blood cells) into the gums and oral tissues).
4. Guinea Pig. 1 year +. Not eating. EMACIATED. Drooling. Had incisors clipped 2 weeks ago by Vet 1 who did not examine further. Still not eating well. "Examine the molars," I showed the young lady the inward pointing sharp points of the lower molars. Anaesthetic isoflurane gas using mask. Clipped teeth. Advised hard pellets. "Separate from the other GP who ate faster," I advised. "He might be bullied." The girl said: "The other GP will scream if separated." I said: "Get a grated barrier to separate them. This GP eats by herself and recover. We assume there is no bullying as we don't see it."
UPDATE: Feb 19, 2012. The guinea pig started eating but died "suddenly" around 3 weeks after my treatment. The owner requested an autopsy. The stomach was full. The lungs were infected and the chest had a lot of blood tinged fluid, causing great difficulty in breathing and death.
Guinea pig not eating for weeks
5. Dwarf Hamster, F, 1 year+, 59g. "He had gone (to heaven)," the lady in her late 20s said to me. "I let her swim (in the basin) longer while I took care of the other 3 hamsters. When I saw her, she was gone. Drowned. Flat out. No movement. I did heart massage a long time. She finally recovered. But she has this sound (like teeth chattering) from her chest. She ate a bit. "How many stool pellets she passed?" I asked. "Only 1 or 2. Normally many as she is a fat hamster and eats a lot."
I put my stethoscope to check the hamster's lungs. Yes, the heart sounds were there but there was these extra loud "crackling sound". Much louder than the heart sounds. Coming from the lungs. The hamster was shaking and breathing faster than normal.
"Have you treated hamsters before?" the lady asked me when I told her that I needed to give the hamster an injection of painkiller, lung fluid-draining medication and antibiotic. If the hamster dies, it will be due to her progression of illness and not due to the injection." She was doubtful about injections. "Well, I never had a case of a hamster that had drowned and had been returned to living," I said. "Singaporeans don't bathe hamsters or I have not got such a similar case. I have done hamster injections for anaesthesia and for itchiness."
"I suppose I have no choice," she gave permission to inject her hamster. My assistant Min held the thick cloth over the first half of the body. I injected the back area under the skin of 0.01 ml. Upon removal of the cloth, the hamster was motionless. The lady was very upset, stroking the hamster's chest and calling her name. I asked her to go outside the cold aircon consult room and into the evening sunlight outdoors. She stroked her hamster. There was a flicker of movement and the hamster's eye moved. She was happy. Booked a cab and thanked me.
UPDATE: Feb 19, 2012. The owner did not return for review.
In conclusion, on this Chinese New Year 2nd day, January 24, 2012, I had a representative sample of pets common in Singapore - dogs, cats, guinea pigs and hamsters. No rabbits.
The updated webpage and images are at: